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PubMed1997

Racial differences in surgically staged patients with endometrial cancer.

This study examined whether differences in survival for endometrial cancer attributed to race are primarily associated with socioeconomic status, comorbid illnesses, molecular genetic alterations, and other disease-related characteristics identified as poor prognostic factors. One hundred fifty-two surgically staged patients with endometrial cancer (37 African-American and 115 European-American women) treated from 1990 to 1994 were analyzed for differences in demographics, disease-related characteristics, and survival. Survival was poorer for African-American women than for European-American women. African-American women had lower socioeconomic status and a higher prevalence of poor prognostic factors. Surgical stage, positive peritoneal cytology, angiolymphatic invasion, cervical stromal involvement, and a history of other malignancies were similar between the two groups. The most important predictors of survival were age at diagnosis, surgical stage, myometrial invasion, positive peritoneal cytology, cervical stromal involvement, tumor grade, aneuploidy, histology, S-phase fraction, number of poor prognostic factors, and race. Racial differences in survival were not explained by socioeconomic status, comorbid illnesses, or estrogen use. When incorporating the number of poor prognostic factors in a survival model with race and surgical stage, race ceased to be of significant prognostic value. In an analysis restricted to women with poor prognostic factors, this phenomena also occurred after adjusting for the number of poor prognostic factors. These findings suggest that the cumulative number of poor prognostic factors, not race, is a more important predictor of survival in endometrial cancer.

Aged↗
PubMed1993

Racial differences in the use of invasive coronary procedures after acute myocardial infarction in Medicare beneficiaries.

We examined differences in the use of invasive diagnostic and therapeutic coronary procedures between white and black Medicare beneficiaries following acute myocardial infarction. We used Medicare hospitalization data for patients aged 65 years or older who were hospitalized with an acute myocardial infarction in 1988, and we followed them through the calendar year to determine whether they received invasive coronary procedures. We used multivariate logistic regression to control simultaneously for multiple potential confounding factors including age, geographic region, poverty, comorbid conditions, access to hospitals equipped to provide invasive procedures, and short-term survival. We calculated odds ratios for racial differences in use of invasive diagnostic procedures (coronary arteriography, cardiac catheterization) and, separately, of myocardial revascularization procedures (coronary artery bypass grafting, percutaneous transluminal coronary angioplasty). We found that the odds of receiving an invasive diagnostic procedure after acute myocardial infarction were 2.0 times greater for white men than for black men (95% CI: 1.8-2.1); for white women, the odds were 1.5 times greater than for black women (95% CI: 1.4-1.6). Following an invasive diagnostic procedure, the odds of myocardial revascularization were 1.8 times greater among white than among black men (95% CI: 1.6-2.0), and 1.7 times greater among white than among black women (95% CI: 1.6-2.0). We conclude that invasive diagnostic and therapeutic coronary procedures are used more often among white than among black Medicare beneficiaries following acute myocardial infarction. Further investigation of this discrepancy will require detailed clinical and attitudinal information from medical records, patients, and physicians.

Black or African American↗
PubMed1993

Racial differences in cell membrane ATPases and cellular cation content in urban South African normotensive and hypertensive subjects.

Platelet and erythrocyte membrane Na+,K(+)-ATPase, Ca(2+)-ATPase and Mg(2+)-ATPase activities and platelet, erythrocyte and serum magnesium, calcium, sodium and potassium concentrations were determined in black (n = 52) and white (n = 24) essential hypertensive patients from the city of Johannesburg in South Africa. The hypertensive groups were matched for age and body mass with black (n = 52) and white (n = 26) normotensive controls. In the black group, platelet and erythrocyte membrane ATPase activities were significantly depressed in the hypertensive subjects. In the white group, there were no significant differences for any of the ATPases studied between the normotensive and hypertensive subjects. Platelet sodium and calcium were significantly increased and serum magnesium, serum potassium, platelet magnesium and erythrocyte magnesium significantly decreased in the black hypertensive group compared to the black normotensive group. In the white hypertensive patients, platelet sodium and calcium were significantly raised and platelet magnesium significantly decreased compared to the normotensive controls. In blacks, platelet magnesium and ATPase activity were negatively correlated with mean arterial pressure. Unlike whites, black hypertensives have widespread magnesium changes with associated cell membrane ATPase depression and cytosolic sodium and calcium accumulation. These results suggest possible racial differences in cellular cation regulation in essential hypertension.

Adenosine Triphosphatases↗
PubMed2005

Racial differences in the frequency of depressive symptoms among community dwelling elders: the role of socioeconomic factors.

In a biracial sample of community dwelling elders (n=4162, the Duke EPESE), African-Americans endorsed more items than Whites on a standardized depression scale, the CES-D, in unadjusted, cross-sectional analyses. However, indices of socioeconomic status (e.g., education and problems meeting needs) were found to mediate the relationship between race and depression. When these socioeconomic variables were included in cross-sectional analyses, the association between depressive symptoms and race reversed such that Whites were significantly more likely to endorse depressive symptoms than African-Americans. Further, whereas in unadjusted, longitudinal analyses, race was unrelated to changes in depressive symptoms over time, with the inclusion of the socioeconomic variables Whites were found to endorse more depressive symptoms than African-Americans. We conclude that socioeconomic variables influence the size and direction of racial differences in the endorsement of depressive symptoms in community dwelling elders.

Black or African American↗
PubMed2000

Regional and racial differences in response to antihypertensive medication use in a randomized controlled trial of men with hypertension in the United States. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents.

BACKGROUND: Stroke incidence and mortality rates are higher in the southeastern region of the United States, which is called the "Stroke Belt." We compared the response to antihypertensive medication use in patients from different US regions. METHODS: The short-term and 1-year efficacy of the antihypertensive medications hydrochlorothiazide, atenolol, diltiazem hydrochloride (sustained release), captopril, prazosin hydrochloride, and clonidine was compared by US region in a randomized controlled trial of 1,105 men with hypertension from 15 US Veterans Affairs medical centers. RESULTS: Compared with patients outside the Stroke Belt, patients inside the Stroke Belt achieved significantly lower treatment success rates of diastolic blood pressure control at 1 year with hydrochlorothiazide (63% vs 41%), atenolol (62% vs 46%), captopril (60% vs 30%), and clonidine (69% vs 43%); there were no differences in treatment success rates with diltiazem (70% vs 71%) or prazosin (54% vs 53%). When controlling for race, patients inside the Stroke Belt had significantly lower treatment success rates with hydrochlorothiazide (P = .003) and clonidine (P = .003), and the lower success rate with atenolol approached significance (P = .15). Regardless of region, blacks were less likely than whites to achieve treatment success with atenolol (P = .02) or prazosin (P = .03) and more likely with diltiazem (P = .05). There was a trend for blacks residing inside the Stroke Belt to have a lower treatment success rate than other race-region groups when treated with captopril (P = .07). Many regional and racial differences in diet, lifestyle, and other characteristics were observed. After adjustment for these characteristics by regression analysis, the effect of residing inside the Stroke Belt remained for captopril (P = .01) and clonidine (P = .01) and approached significance for hydrochlorothiazide (P = .10). CONCLUSIONS: Hypertension in patients residing inside the Stroke Belt responded less to the use of several antihypertensive medications and important differences were shown in a number of characteristics that may affect the control of blood pressure, compared with patients residing outside the Stroke Belt.

Adult↗
PubMed1999

Association of a variant of the angiotensinogen gene with pure type of hypertension in pregnancy in the Japanese: implication of a racial difference and significance of an age factor.

The contribution of genetic factors to hypertension in pregnancy, including pre-eclampsia, has been well documented. The association with a common molecular variant of the angiotensinogen (AGT) gene, in which methionine (M235) is substituted for threonine (T235) at residue 235, has been reported in both Caucasians and Japanese. In the present study, we examined 115 cases of pure type of hypertension in pregnancy (PHP) and 381 normal pregnant controls in order to look for subgroups in which the AGT gene is the major factor in the PHP pathogenesis. By classification of PHP cases according to the clinical diagnosis, gravidity, and maternal age, we found significantly higher frequencies of T235 in both all PHP patients and preeclampsia/eclampsia patients than in normal controls. These results are discordant with those reported for Caucasian subjects where only a group of preeclamptic primigravidae was associated with the AGT variant, possibly indicating the existence of a racial difference. We also found that the variant frequency was significantly higher in the PHP subgroup with maternal age of 20-34 years (0.93) than in a subgroup of multigravid PHP patients age 35 years or older (0.77, P < 0.05) or in normal controls of age 20-34 years (0.76, P < 0.001). The result indicates that the AGT variant plays a significant role in hypertension in the age group 20-34 years.

Adult↗
PubMed2004

Racial differences in the outcomes of patients with diastolic heart failure.

BACKGROUND: More than half of all patients with congestive heart failure have preserved left ventricular systolic function. This is particularly common in African American patients, yet there have been few studies examining the long-term natural history of this disorder in African-American and white patients. METHODS: We studied 2740 white and 563 African American patients with class II to IV symptoms and preserved systolic function (ejection fraction >40) identified in the Duke Cardiovascular Databank from 1984 to 1996. Unadjusted and adjusted 5-year survival rate comparisons were performed with Kaplan-Meier and Cox proportional hazards models, respectively. RESULTS: The 5-year survival rates were 68% for African American patients and 70% for white patients (P =.55). However, after adjusting for known risk factors, African American patients had a significantly higher mortality risk than white patients (hazard ratio [HR], 1.34; 95% CI, 1.13-1.60). This racial difference in survival rate was most prominent in patients with a non-ischemic etiology (HR, 1.6; 95% CI, 1.2-2.0) as compared with patients with ischemic heart failure (HR, 1.1; 95% CI, 0.9-1.4). CONCLUSION: Among patients with heart failure and preserved left ventricular systolic function, African American patients have a worse long-term prognosis than white patients. These results are important because of the prevalence of this condition in African American patients and their potential heterogeneous response to many heart failure therapies.

Black or African American↗
PubMed2004

Racial differences in enrolment in a cancer genetics registry.

BACKGROUND: Lower enrolment of minorities into research studies has been reported frequently. Most studies have little information about nonparticipants, making it difficult to identify characteristics associated with enrolment and how they might vary by race. METHODS: Women who had previously participated in a population-based, case-control study of breast cancer in North Carolina were invited to enroll in a cancer genetics registry. Detailed questionnaire data on sociodemographic characteristics and cancer risk factors were available for all women. We compared characteristics of women who agreed to be in the registry with those who were deceased, were unlocatable, or declined enrolment. Unconditional logistic regression analyses were done to identify predictors of enrolment. RESULTS: Enrolment rates were markedly lower among African Americans than Whites (15% and 36%, respectively) due to both lower contact rates (41% versus 63%) and lower enrolment rates among those contacted (37% versus 58%). Logistic regression models suggested that racial differences in enrolment were not due to socioeconomic characteristics or other cancer risk factors; race was the only significant predictor of enrolment in multivariable models (odds ratio 0.41, 95% confidence interval 0.23-0.72). CONCLUSIONS: Although all women had previously taken part in a research study, African American women were less likely to enroll in the cancer genetics registry than White women. A possible explanation of these findings is that studies of genetics may present particular concerns for African Americans. Further research is needed to identify attitudes and issues that present barriers to participation among minorities.

Adult↗
PubMed1992

Demographic factors influencing cyclosporine pharmacokinetic parameters in patients with uremia: racial differences in bioavailability.

The impact of several demographic and blood biochemistry factors on the pharmacokinetics of the immunosuppressive drug cyclosporine were studied in 187 patients with uremia. All patients underwent a pharmacokinetic evaluation including a 3 mg/kg intravenous dose of cyclosporine and a 14 mg/kg oral dose of cyclosporine. Cyclosporine was analyzed by specific monoclonal radioimmunoassay on whole blood samples. Statistical analysis included univariate analyses and stepwise multiple regression analysis. Major findings were as follows: The bioavailability (F) of cyclosporine was significantly lower in black patients than in white patients (mean values of 30.9% +/- 12.3% and 39.5% +/- 16.5%, respectively; p < 0.001). This difference was noted both before transplant and at 1 week after kidney transplantation, at which time the corresponding mean values were 28.6% +/- 15.5% and 36.1% +/- 15.5%, respectively (p < 0.01). Other factors that correlated with F were serum triglyceride (positively) and blood hemoglobin concentrations (inversely). Patients with diabetes displayed a longer mean absorption time than other patients and a larger volume of distribution of cyclosporine at steady state (VSS). Other factors that correlated with VSS were serum albumin concentration and patient height. Cyclosporine clearance (CL) decreased with patient age and also with increasing concentrations of serum triglycerides and blood hemoglobin. It was lower in patients with the pretransplant diagnosis of nephrosclerosis than in patients with other diseases. Several pharmacokinetic parameters correlated with the level of substances that can potentially bind cyclosporine in the blood. Serum triglycerides correlated with maximum concentration, time to maximum concentration, F, and CL. Blood hemoglobin concentration and blood hematocrit correlated with F, CL, and intravenous mean residence time. Although several relationships were observed between demographic factors and cyclosporine pharmacokinetics, the racial difference in F is of great clinical significance and may contribute to the poorer outcome observed after kidney transplantation in black patients.

Adult↗
PubMed1994

Racial difference in cardiac sarcoidosis incidence observed at autopsy.

The most commonly involved organ in sarcoid related death has been reported to be the lung in western countries, while it was the heart in the Japanese autopsy series. In order to verify this different pattern of death, autopsy records were reviewed in two United States institutions and in Japanese nation-wide data. In Japanese, male to female ratio was 1:2 and a high frequency of sarcoidosis in females over 50 years of age was observed. Male to female ratio in Caucasian sarcoidosis autopsy was nearly 1:1. In Afroamericans, it was nearly 1:2, and the age distribution showed that this female predominance was due to a high number of sarcoidosis in females over 40 years of age. The frequency of sarcoidosis in Caucasian autopsies was higher than in Japanese autopsies. The number of involved organs was smaller in Caucasians than in Afroamericans or in Japanese. The incidence of cardiac sarcoid granuloma in Japanese was significantly higher than that seen in Caucasians and Afroamericans. The commonest cause of death in sarcoidosis of Caucasians and Afroamericans was from non-sarcoid diseases, while the major cause of sarcoid-attributed death was pulmonary sarcoidosis in Afroamericans. Japanese showed the highest rate of cardiac sarcoid-attributed death. Possible factors relating to this high incidence of sarcoidosis in elderly females and the racial difference in cardiac sarcoidosis were discussed.

Adolescent↗
PubMed1999

Racial differences in the management of unstable angina: results from the multicenter GUARANTEE registry.

BACKGROUND: Prior studies, usually conducted with the use of insurance databases, have shown differences in the use of cardiac procedures between black patients and white patients hospitalized with various types of coronary artery disease. However, few data are available in prospectively collected cohorts of patients with unstable angina or on the use of appropriate medications or interventions. METHODS AND RESULTS: We evaluated 2948 consecutive patients with unstable angina admitted to 35 hospitals across the United States in 1996, comparing nonwhite and white patients. Seventy-seven percent of patients were white, 14% were black, 4% were Hispanic, 1% were Asian, and 3% were other or unknown race. Differences were seen in coronary risk profile, with a higher incidence of hypertension and diabetes mellitus in nonwhites. Cardiac catheterization was performed less often in nonwhites compared with whites (36% vs 53%, P =.001). Even in patients meeting the criteria for appropriate catheterization in the Agency for Health Care Policy Research unstable angina guidelines, fewer nonwhites underwent catheterization (44% vs 61%, P =.001), but among these, fewer nonwhites had significant coronary stenosis (72% vs 90%, P =.001). However, among patients catheterized who had indications for revascularization, angioplasty and coronary artery bypass grafting were performed equally often in nonwhites and whites. CONCLUSIONS: Current guidelines would recommend more aggressive use of cardiac catheterization for nonwhite patients. However, our findings suggest that racial differences may need to be included in the diagnostic and interventional algorithms.

Aged↗
PubMed1996

Racial differences in gastric function among African Americans and Caucasian Americans: secretion, serum gastrin, and histology.

We measured gastric juice fluid output, acidity, tonic strength (osmolality), and pepsin concentrations basally and after the injection of pentagastrin in 120 healthy African Americans and 60 Caucasian Americans of similar age and gender. Sera for basal gastrin concentration and IgG for antibody to Helicobacter pylori (Hp) organisms also were obtained, as were gastric body mucosal biopsies to ascertain the presence or absence of Hp or gastritis. Gastric juice hydrogen ion concentrations and osmolality were significantly lower in African Americans than in Caucasians. At the same time, African Americans had significantly higher gastric juice fluid outputs than did Caucasians. From measurements of gastric juice fluid output, acidity, and osmolality, we used a previously validated method for calculating gastric HCO3- and H+ secretion, as well as nonparietal and parietal fluid secretion. Gastric HCO3 secretion and nonparietal fluid were significantly higher in African Americans, while H+, parietal fluid, and pepsin secretion rates were nearly identical in the two racial groups. Basal serum gastrin concentrations and antibody titers to Hp also were significantly higher in African Americans (p < .001). Mucosal biopsies demonstrated a much higher prevalence of Hp infection and chronic active superficial gastritis in African Americans than Caucasians (p < .001). When only Hp-negative subjects were considered, racial differences in gastric secretion and basal serum gastrin concentration were still present. The mechanism or mechanisms causing higher gastric bicarbonate and nonparietal fluid secretion and for higher serum gastrin concentrations in African Americans remains to be elucidated.

Adult↗
PubMedDate not supplied

Racial differences in parenting dimensions and adolescent condom use at sexual debut.

OBJECTIVES: Parenting style may be a determinant in reducing adolescent risk behavior. Previous studies have relied on a typological parenting approach, with classification into four groups: authoritative, authoritarian, permissive, and neglectful. In this study, two distinct parenting dimensions, demandingness and responsiveness, were examined as independent predictors of adolescent condom use. DESIGN AND SAMPLE: This study used a subsample of the National Longitudinal Study of Adolescent Health (Add Health) that included 153 adolescent-mother pairs. MEASUREMENT: Maternal demandingness and responsiveness were measured using Wave I mother interviews. Logistic regression analyses were used to predict adolescent condom use at sexual debut at Wave II and to assess moderation by gender and race. RESULTS: (1) Maternal demandingness predicted increased likelihood of condom use in African American adolescents but decreased likelihood of condom use in White adolescents; (2) maternal responsiveness did not predict condom use; and (3) gender moderation was not present. CONCLUSIONS: To provide appropriate family counseling, public health nurses need to consider racial differences in contraceptive practices. Education regarding parental supervision practices should be considered as part of nursing interventions intended to increase condom use in African American adolescents.

Adolescent↗
PubMed1994

Racial differences in adenocarcinoma of the prostate in North American men.

Black men represent a particularly high risk group for the development of prostate cancer. Current recommendations are that all men over age 50 be screened for prostate cancer annually with a digital rectal examination (DRE) and PSA. Moreover, it has been recommended that men in high risk groups, including blacks and men with a family history of prostate cancer, be screened at an earlier age. At the present time, no adequately performed prospective study has demonstrated a reduction in mortality rate attributable to annual prostate cancer screening. Preliminary reports have suggested that the proportion of men with organ confined tumors increases with PSA based screening, and that a reduction in prostate cancer mortality via screening is feasible. In light of these preliminary studies, increased efforts toward patient awareness and PSA screening are certainly warranted in the black community. Hopefully the result of such programs would be to increase the percentage of black men diagnosed with organ confined prostate cancer. However, the etiology of these striking racial differences remains to be defined. To date no consistent data have been presented which can explain these observations. It is likely that multiple factors will be involved including socioeconomic, environmental, dietary, and genetic. Lastly, little is known of the molecular genetic factors, tumor suppressor genes and/or oncogenes, that play a role in prostate cancer in black men. Increased research efforts are needed in order to understand this problem at the molecular level.

Adenocarcinoma↗
PubMed1992

Racial differences in maximal vasodilatory capacity of forearm resistance vessels in normotensive young adults.

This study was performed to determine whether alterations in vascular structure exist in a biracial population of young (age 22.3 +/- 0.6 yrs [mean + SE]) normotensive men. We examined maximal vasodilatory capacity in 21 blacks and 20 whites (average blood pressure = 122/75 and 118/72 mm Hg, respectively). Forearm blood flow was determined at rest and after 10 min of ischemic handgrip exercise using venous occlusion plethysmography. Forearm vascular resistance was computed from blood flow and mean arterial blood pressure determined by auscultation. Minimum forearm vascular resistance was 23% higher in blacks (2.60 +/- 0.60) than in whites (2.11 +/- 0.41) (P = .005), and was unrelated to parental history of hypertension. The regression equation for minimum forearm vascular resistance (Y) and casual blood pressure (X) for blacks was Y = -1.782 + 0.0487X (r = 0.522); for whites it was Y = -1.165 + 0.0367X (r = 0.418). When the data were covaried on resting mean arterial blood pressure, blacks still had a higher minimum forearm vascular resistance (P = .014). The results suggest a racial difference in the vascular structure of the forearm resistance vessels.

Adult↗
PubMed1987

Racial differences in vitamin B12 levels in the United States.

Studies from Africa have demonstrated that black people have higher vitamin B12 (cobalamin) levels than do white people. The authors compared healthy white people, black people, and Latin-Americans in the United States. Their study is also the largest in which the effect of race and sex on the cobalamin levels has been examined. Analysis of 233 healthy subjects showed that black people had significantly higher (P less than 0.0001) vitamin B12 levels than did white people. Latin-Americans had levels intermediate between those of white and black people, although their levels were significantly different only in comparison with white people (P = 0.0029). Based on the study of 305 healthy subjects, no sex difference in vitamin B12 levels was noted. Conflicting claims have been made on sex difference in the past. The authors conclude that there is a racial but not a sex difference in vitamin B12 levels in the United States. Like African black people, black people and Latin-Americans in this country have significantly higher vitamin B12 levels than do white people. This finding supports the thesis that genetic factors contribute to the racial differences in vitamin B12 levels.

Black or African American↗
PubMed2003

Racial differences in mammographic breast density.

BACKGROUND: African American women have a lower incidence but a higher mortality from breast carcinoma than Caucasians. A proposed explanation for this discrepancy is the decreased efficacy of screening among African American women. Increased breast density in African American women may result in decreased sensitivity of mammography. The purpose of this article is to determine whether there is a difference in mammographic breast density between African American and Caucasian women. METHODS: A series of 769 women were recruited from 5 sites. Mammograms were reviewed centrally by seven reviewers using Breast Imaging Reporting and Data System categories converted to numeric values. The mean mammographic densities for Caucasian, African American, and Latina patients were compared using a two-way analysis of covariance. The mean values for each race were estimated adjusting for the reader as well as for each patient's age and body mass index (BMI). RESULTS: African American women had the lowest mean breast density. The reported density in this group was 2.43, compared with 2.69 among Caucasians and 2.65 among Latina patients. After adjusting for age and BMI as well as the reader, there was still an independent racial effect on breast density (P = 0.0050). CONCLUSIONS: Mammographic breast density was lower in African American women than in Caucasians and Latinas. This discrepancy may be an intrinsic racial difference due to undetermined causes. Factors, such as the growth rate of tumors and the incidence of calcifications, must be studied to confirm that other forces do not have a negative impact on the efficacy of screening mammograms in African American women.

Adult↗
PubMed2005

Attenuation of racial differences in health service utilization patterns for previously uninsured children in the Delta.

CONTEXT: A school-based health insurance program for children of the working poor was conducted in 2 isolated, rural communities in the Lower Mississippi Delta region. The larger of the 2 communities had an array of locally available health care providers, whereas the smaller community did not. In response to this lack of available care, the project designed and delivered outreach programs, including transportation to providers. PURPOSE: The purpose of this paper is to examine the role of race, age, and gender in the relationships between the utilization of care and the impact of outreach programs. METHOD: General estimating equation models are used to examine the response of utilization variables to race, age, gender, and community. Four years of insurance claims data are analyzed. FINDINGS: Race is seen to be an important component of utilization. The majority of participants were African American; however, children receiving prescription services, emergency room care, routine physician visits, and hospital outpatient services were more likely to be white. Outreach programs in vision and dental services were found to eliminate racial differences and increase utilization. A relatively strong gender effect was found in prescription, wellness, vision, and dental services. CONCLUSIONS: Previous research has shown differences by race in utilization of care. Our findings show that targeted outreach programs can significantly diminish these differences. Findings also suggest that barriers to health care for poor rural children are closely linked to transportation and availability of providers, not merely to cost of care or insurance.

Black or African American↗